Organization
DVA RENAL HEALTHCARE INC
Active
Organization
DVA RENAL HEALTHCARE INC
Active
Other names
Homerville Dialysis
Organization subpart
No
Provider details
NPI number
Authorized official
THOMAS O USILTON JR. (GROUP VICE PRESIDENT)
(770) 541-7922
Entity
Organization
Contact information
Practice address
180 CARSWELL ST, STE 180, HOMERVILLE, GA 31634-2413
(912) 487-0092
(912) 487-3533
Mailing address
5200 VIRGINIA WAY, SUITE 400 L&C DEPT, BRENTWOOD, TN 37027-7569
(615) 320-4218
(303) 209-7825
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
ESRD001179
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PENDING
—
NY
Enumeration date
03/14/2006
Last updated
07/10/2007
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